ABSTRACT
Background: Even though there has been significant success in reducing maternal mortality worldwide, Nigeria alone still accounted for about 28% of the global maternal deaths in the year 2020. Hence, we aim to assess the relationship between maternal health literacy and quality of care for pregnant women attending antenatal care (ANC) services in Primary Health Care (PHC) centres in Lagos state, Nigeria.
Methods: We conducted a cross-sectional study among 570 women attending ANCs in Primary Healthcare centers, Private hospitals and homes of Traditional Birth Attendants (TBA) in Ikorodu LGA of Lagos state. We included 8 PHCs, 2 private hospitals and 15 TBAs. We excluded facilities that did not offer both ANC and delivery services. We described respondents’ sociodemographic characteristics using summary statistics. The maternal literacy tool had 14 items with a 3 points likert scale and it was adapted from a past study on maternal literacy. We calculated the mean score as 37.0. Quality of care received was measured using 13 services to be provided during ANC visits based on guidelines from WHO and other literature. Using the raw scores, we conducted linear regression to check for association between maternal health literacy and ANC service quality.
Results: More than half (64.2%) of the respondents were aged 25 to 34 years, with a mean age of 27.9, and about three-quarter (76.7%) of them were Yorubas. Three hundred and fifty (61.4%) of the women scored equal or higher than the mean maternal literacy score (37.0) and 350 (61.4%) received at least 9 out of the 13 expected services. The mean ANC service score received by women was 9.8 ± (3.6) and was higher in PHCs (10.5 ± 3.0) compared with private (9.7 ± 3.6) and TBA (7.3 ± 4.2) facilities (p<0.001). Maternal literacy was positively associated with quality of care. Similarly, women residing in urban settlement had higher odds to receive higher quality of care compared to those residing in rural areas.
Conclusion: Our study shows that the type of healthcare facility a woman attended was a determining factor to the quality of ANC services received. The likelihood of receiving higher quality ANC service is greater in primary health centres than in private hospitals or homes managed by TBAs. The government, therefore, must adopt a multidimensional approach that includes interventions targeting individuals, households, communities, and other facility types in other to improve maternal and child health outcomes.